Each year, cardiac complications occur within 30 days after
major non-cardiac surgery in more than 10 million people worldwide.Non Cardiac
surgeries may improve the quality and patient’s life may get better or
prolonged, however these surgeries may develop complications such as death from
Cardiac causes, myocardial ischemia (MI), cardiac arrest or conjuctive heart
failure. Unfortunately, a large proportion of ischemic episodes go undetected
during surgery and in the postoperative period. Also, it is noticed that MI
remains undiagnosed and physicians rarely administer therapy and plan secondary
prevention in patients who have suffered from perioperative unstable angina or
MI. The risk of subsequent cardiac events increases further due to lack of
satisfactory management.
Knowing the clinical relevance of cardiac complications in the
setting of non-cardiac surgery, preventive strategies for preoperative risk
stratification have been proposed since 1977. Models were developed looking for
associations between preoperative variables such as age, type of surgery,
co-morbidities etc and the risk of cardiac complications in a cohort of
patients undergoing non-cardiac surgeries called as “Derivation Cohort”.
Variables that have independent predictive value using logistic regression
analysis are incorporated into the risk index. The accuracy and validity of
this risk index is then tested in a separate cohort called “validation cohort”.
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